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Osteoarthritis
Coping and Adaptation of Older Adults with Osteoarthritis
a report by
Monique AM Gignac
Arthritis Community Research and Evaluation Unit, Toronto Western Research Unit, University Health Network and the University of Toronto
Osteoarthritis (OA) is by far the most common type of arthritis and is recommend pharmacological management of pain with little or no
a leading cause of pain, physical disability and healthcare service use discussion of drug effects and self-management strategies.
15,19
among older adults.
1–4
However, despite its prevalence and impact, As a result, older adults report becoming frustrated with health
there has been relatively little interest in the ways in which older adults professionals, can lose trust in them and not follow advice and
cope with the disease. By ‘coping’, researchers generally mean both remain uncertain about where else they can seek help or what to do
conscious and unconscious efforts made by individuals to manage to cope with OA.
15,19
stress and negative feelings that are perceived as a drain on one’s
resources.
5,6
Defining coping as ‘effortful’ is critical and distinguishes it Where does this leave us? One of the potential limitations of the
from automatic or routine thoughts and behaviours aimed at coping literature is the almost exclusive reliance on coping checklists.
managing daily life. While useful descriptively and as a means of comparing the strategies
used across different stressors, checklists have been criticised by a
Much of the existing coping research uses samples of predominantly number of researchers.
20
They are limited in their ability to illuminate
older adults, but does not focus specifically on issues of ageing. coping processes, often confound emotion-based coping with
Instead, checklists have been used to measure coping strategies psychological outcomes and appraisals, may contain socially desirable
with an emphasis on managing symptoms of pain.
7–11
For example, items that inflate the frequency of particular strategies and tend to
research on OA knee pain by Keefe and colleagues uses the Coping focus less on coping behaviours and more on a wide range of
Strategies Questionnaire (CSQ) and finds that adults who report cognitive efforts.
using pain control and rational thinking to cope have lower pain
scores, better health status and lower psychological distress.
7
As a result, some researchers have examined the coping and
Other studies find that active coping efforts (e.g. problem-solving) adaptation of older adults using other theoretical perspectives. For
predict less depressive effects, while passive coping strategies (e.g. example, models of successful ageing suggest that older adults may
wishful thinking) predict a worsening negative mood.
11
Recent improve in their ability to monitor their emotions and cope over time.
6
research has also utilised daily diary and within-day assessments of Research by Baltes and colleagues
21,22
posits that adaptation across the
pain symptoms and coping.
12,13
These studies typically reveal more lifespan involves selective optimisation with compensation (SOC). That
complex inter-relationships of pain, coping and mood, and caution is, older adults learn to compensate for health problems and optimise
against pitting coping efforts against one another as many types of capacities that they still retain. To date, there are few studies of SOC
coping strategies co-occur.
12,13
processes in arthritis. One exception is a study of older adults with OA
that used an inductive approach with open-ended questions and
In contrast, other OA studies with older adults above 60 years of age content analysis to reveal a wide array of behavioural adaptations to
find that these individuals frequently endorse coping efforts reflecting manage activity limitations in different domains of life. These
resignation or doing nothing.
14,15
This suggests that many older adaptations included:
adults may believe they are unable to do much to deal with OA in their
lives. In fact, older adults often minimise or normalise their OA, • selection, where time spent on some activities was reduced either
perceiving symptoms such as pain, stiffness and fatigue as common because of disease symptoms or in order to spend additional time
and to be expected as one ages, rather than as indicative of a on other tasks;
treatable health problem.
16–18
This strategy is often further endorsed • compensation, where behaviours and activities were modified or
by health professionals, who either make no recommendations to assistive devices used to perform activities;
manage OA symptoms, attributing them instead to ageing, or • optimisation, where older adults anticipated frequent problems
related to their OA and expended efforts to avoid them occurring
(e.g. planning, pacing and exercise); and
Monique AM Gignac is a Senior Scientist with the Division of Healthcare and Outcomes
Research, and a Research Investigator with the Arthritis Community Research and
• help from family and friends, as well as from health professionals.
23,24
Evaluation Unit at the Toronto Western Research Institute, Canada. She is also an
Associate Professor in the Department of Public Health Sciences at the University of
The findings revealed that older adults were far from passive in dealing
Toronto, and an Adjunct Scientist with the Institute for Work and Health (IWH). Dr Gignac’s
research is in the area of health psychology. She studies coping and adaptation to chronic with difficulties related to functioning with OA. Instead, they revealed
stress, especially chronic illness and disability.
the flexibility of the coping strategies employed by older adults and the
E: gignac@uhnres.utoronto.ca sizeable reserves they possessed with which to accommodate activity
limitations and to continue participation in valued roles.
74 © TOUCH BRIEFINGS 2008
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